Physical therapy interventions for back care in children and adolescents are successful in significantly increasing healthy behaviors and knowledge acquired both in the posttest and in the follow-up, say authors of a meta-analysis published in BMC Musculoskeletal Disorders. The combined treatment of postural hygiene with physical therapy exercise exhibits the best results. The small number of studies limits the generalizability of the results, they add.
The authors located studies from the Cochrane Library, Medline, PEDro, Web of Science and IME, and other sources. The search period extended to May 2012. To be included in the meta-analysis, studies had to use physical therapy methodologies of preventive treatment on children and adolescents and compare a treatment and a control group. Treatment, participant, methodological, and extrinsic characteristics of the studies were coded. Two researchers independently coded all of the studies. As effect size indices, standardized mean differences were calculated for measures of behaviors and knowledge, both in the posttest and in the follow-up. The random and mixed-effects models were used for the statistical analyses. Sensitivity analyses were carried out to check the robustness of the meta-analytic results.
A total of 19 papers fulfilled the selection criteria, producing 23 independent studies. On average, the treatments reached a statistically significant effectiveness in the behaviors acquired, both in the posttest and in the follow-up (d+ = 1.33 and d+ = 1.80, respectively), as well as in measures of knowledge (posttest: d+ = 1.29; follow-up: d+ = 0.76). Depending on the outcome measure, the effect sizes were affected by different moderator variables, such as the type of treatment, the type of postural hygiene, the teaching method, or the use of paraprofessionals as cotherapists.